Service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017

Abstract

Background Better understanding of the dynamics and temporal changes in manual therapy service utilisation may assist with healthcare planning and resource allocation. The objectives of this study were to quantify, describe, and compare service utilisation trends in the manual therapy professions within the Australian private healthcare setting between 2008 and 2017. Methods Data regarding the number of services, total cost, and benefits paid were extracted for each manual therapy profession (i.e. chiropractic, osteopathy, and physiotherapy) for the period 2008–2017 from the Australian Prudential Regulation Authority. The number of registered providers for each profession were obtained from the Australian Health Practitioner Regulation Agency. Descriptive statistics were produced for two time periods (i.e. 2008–2012 and 2013–2017) for each manual therapy profession. Annual percentage change during each time period was estimated by fitting Poisson regression models. Test for the equality of regression coefficients was used to compare the trends in the two time periods within each profession, and to compare the trends across professions within a time period. Results A cumulative total of 198.6 million manual therapy services with a total cost of $12.8 billion was provided within the Australian private healthcare setting between 2008 and 2017. Although service utilisation and total cost increased throughout the ten-year period, the annual growth was significantly lower during 2013–2017 than 2008–2012. Whereas osteopathy and physiotherapy experienced significant annual growth in the number of services and total cost during 2013–2017, negative growth in the number of services was observed for chiropractic during the same period. The annual number of services per provider declined significantly for chiropractic and physiotherapy between 2013 and 2017. Conclusion Service provision under private health insurance general treatment cover constitute a major source of revenue for manual therapy professions in Australia. Although manual therapy service utilisation increased throughout the ten-year period from 2008 to 2017, the annual growth declined. There were diverging trends across the three professions, including significantly greater decline in annual growth for chiropractic than for osteopathy and physiotherapy.

Impact of the COVID-19 Pandemic on Manual Therapy Service Utilization within the Australian Private Healthcare Setting

“…There are strengths and limitations of the present study. This research builds on our previous reports of manual therapy service utilization within the Australian private healthcare setting [ 11 , 12 ]. We added an inflation adjustment for all dollar values to remove the effect of inflation from our analyses.…”

“…The magnitude of the decline in manual therapy service utilization during the COVID-19 pandemic was not uniform across the three professions, with physiotherapy and chiropractic experiencing the largest and smallest relative reductions, respectively. The exact reason for this difference is unclear, but it may be related to differences in revenue streams (e.g., proportion derived from private health insurance) and patient characteristics (e.g., level of disposable income) across the three professions [ 12 ]. For instance, as the COVID-19 pandemic has unfolded and loss of income became more prevalent in the population, perhaps Australians have forfeited their private health insurance with general treatment cover as a cost-saving measure.…”

“…The manual therapy services provided by these professions are predominately paid for by non-government sources (i.e., private health insurers and individuals). Studies have documented increased utilization of manual therapy services over time in Australia, albeit with diverging trends across professions [ 11 , 12 ]. It has been estimated that approximately 21.6 million manual therapy services with a total cost of AUD 1.4 billion were provided within the Australian private healthcare setting annually in the period between 2013 and 2017, which represented a significant increase from the preceding five-year period [ 12 ].…”

Can Haglund’s Syndrome Be Misdiagnosed as Low Back Pain? Findings from a Case Report in Physical Therapy Direct Access

“…It is noteworthy that our comparison of the GP-led care and the DA model of care has demonstrated a potential reduction of 32 days in favor of the latter (see Figure 5 ), resulting in a faster pathway, even when a proper medical referral is needed. Unfortunately, even if DA has become a common practice in some countries, such as the Netherlands [ 13 ], the United States and Australia [ 24 , 32 ], this practice is still a gray area around the world. From the patient’s perspective, the thorough assessment and physical examination conducted by the PT and his ability to successfully identify a MSK disorder needing a proper medical referral, has demonstrated the professional skills of the PT and a comprehensive approach toward the patient’s health status.…”

Letter to the Editor: “The effect of chiropractic care on infantile colic: results from a single-blind randomised controlled trial” and “Identifying potential treatment effect modifiers of the effectiveness of chiropractic care to infants with colic through prespecified secondary analyses of a randomised controlled trial”

“…Firstly, manual therapy was researched not "chiropractic care"; the intervention is used by multiple professions [1].…”